BACKGROUND: Establishing an instrument sterilization program for physician-based practices (PBP) that are under a hospital license is an important aspect of a successful outpatient infection prevention (IP) program. PBP's struggle with the space and resources (staff and money) to adequately manage the sterilization of reusable instruments. Our objective is to develop a process that allows the PBP to operate efficiently and effectively but still be compliant with proper instrument reprocessing.

METHODS: We created a program that removed all tabletop autoclaves and sterilization practices from the PBPs and provided them a service to have their instruments reprocessed at the hospital's sterile processing department. We obtained locking biohazard bins for the dirty instruments, red carts that housed the bins and green carts that held clean instruments returned to the PBP. We purchased a temperature-controlled truck that had segregated clean and dirty areas that securely held the carts and was only used for the transport of instruments. We established a schedule for pick up and drop off that accommodated each PBP's schedule. We established (up front) a 48?hour instrument turnaround time (TAT) for all practices. We held meetings with each PBP leadership team that discussed expectations of the program.

RESULTS: The TAT was the most difficult aspect for the PBPs to manage in the beginning. All practices obtained additional instruments to accommodate the 48-hour TAT. Pick up schedules were adjusted to account for travel time and parking limitations that were not initially recognized. All PBPs effectively relinquished on site instrument sterilization practices without incident.

CONCLUSIONS: Removing instrument sterilization from the PBPs provides an effective way to assure compliance with sterilization practices in an outpatient setting. It allows the PBP to concentrate on taking care of their patients and leaves reprocessing of instruments to the hospital sterile processing department.